P - 76299• REQUEST FOR ELECTRICAL INSPECTION
1�� 7 f- 5 3 9 0 Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�' 4— - ' ,�651) 642-0800 TTY/MRS 1-800-627-3529 www.eleciricity.state.mn.us
Qescribe -uaing the back of the whfte copy if necessary - the work covered by this request:
EKL�EL EhlEhG'� S��'EFi'S SWTTCH
CES / POWER SUPPLIES
to 400 Ampere @ $25
)1 Eo 800 Artlpere Q $50
�ve B00 Ampere @ $75
ITS/FEEDERS
to 200 Am�ere @ $5
bove 200 Ampere @$10
�, CQMMUNICATION, REMOTE CONTROL,
ITS, CIRCUITS OF LESS THAN 50 VOLTS
acb 5ystem Devkx or Apparatus @$.50
ADDITIONS TO THE GENERAL F
FAMILY DWELLINGS (PER UNIn
to 12 Unds @$50 Per Unit
ach Addttional Unit @ $25
OTHER ADDITIONAL FEES
ghUng ReVOfit @ $.25 per Fixture
enter Phrot Irrigation Boom @ $40
anufactured Home Park Lots na $25
Traffic Siqnal Standard
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two InspecUon Trips Each Dwelling Unit @$80
total fee is $201 � � B= �'�
the el�trical insteVation descriYred herein an the dat� sta�:
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WSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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�7975392
REC'D � UN 14 2001
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�� - Rough-in InspecUon Required7 ❑Yes � No Inspection Other Than Rough-In: [�Ready Now ❑Wfli Call
b� �. �..�'Q i� You must cell the inspector when ready! Date Ready:
I certiiy that I am the fy� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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Township Secfion Range Fire No. Cou `'
OWnerlOccupant Name Please Provide Two (2) Phone Numbers Inciuding Area Code
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�lectriql Utldty Electrical Utility Address
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Conba�[Or / Company Name Contrador License Number Master Electrician or Power Limited Technician
HUhli" ELECTfiIC CDFiF'OFiATIC�i'�I CA cJi)'c3$.,� ��nseNumber
MaN4ng Addrass (COntractor, Company or Owner Performing Installation)
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Authoriaed Slgnature (Contracmr or Owner Pedorming Installadon) Please Provide Two (2) Phone Numbers Including Area Code
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